Roundtable- Feeding

Now that we’ve got the nuts and bolts of what you’ll need for the baby out of the way, we can start the more in-depth topics. This week will be devoted to feeding. I breast-fed solely for the first 9 months or so. Therefore I’m going to focus on breast-feeding and hope that some other pros can chime in with information about bottle-feeding a newborn. We did give Henry formula from the time he was about 10-12 months though so feel free to ask any questions you might have and if I don’t know the answer hopefully somebody else will.

Also, since we have a whole week on this topic I thought I might do this in a bit more stream of conscious fashion. My primary goal is to help you understand the basics and to at least cover enough to prompt questions you might have. I really recommend at least skimming the Breastfeeding Mothers Companion if you are planning to breastfeed. It covers just about everything you need to know and also helps you know what kind of problems might crop up and how to handle them.

Feeding Basics
At first…
As soon as your baby is born, you’ll want to try to breastfeed. Lots of babies take right to the breast and others might struggle around with “latching” on, i.e. getting the right suction with their mouth to activate the milk ducks. Either way, trying breastfeeding out at this point is a great thing for you and your baby. If s/he’s not that interested in feeding it’s not a big deal and you can simply try again a bit later. If you’re planning to breastfeed, you’ll want your baby to room in with you (i.e. stay in the hospital room with you instead of the nursery) so that you can “feed on demand.” This means when the baby cries you consider feeding as one of the key things they might need—in addition to being held or being changed.

For the first several days you don’t actually produce the normal milk you’re baby will eat once you’re “milk comes in.” At first he brings down colostrom which is a thick yellowish milk that is very rich in fats, proteins and antibodies. Supposedly it also helps to clear the meconium out of the baby. At this point your breasts probably won’t be that different from how they were at the end of your pregnancy.

Engorgement
Somewhere around 3-4 days postpartum though, your milk will come in and your breasts will get really absolutely gigantic and very hard. This is engorgement. Your body has been told to start producing milk, but it doesn’t really know how much your baby needs or when s/he needs it so you’ve got an oversupply. You’re encouraged to feed whenever the baby is hungry and over a few days your breasts should calm down a bit. Your body will figure out approximately when your baby tends to eat and your milk will “let down” once your baby starts to suck. In the meantime people swear by cold cabbage leaves around their breasts (I never tried that one), massaging your breast before nursing (from top of breast towards nipple) and cool compresses up to 20 minutes before feeding. Generally engorgement passes within 24 hours—mine lasted more like 36-48 but eventually went away on it’s own as well.

Timing/Frequency
Most things you read will tell you that your newborn will need to eat every 2-3 hours. I think this is generally true although sometimes they certainly want to eat more frequently and sometimes they will go longer periods between feedings—especially at night. What’s really grueling about this, and that I didn’t realize until Henry was born is that it’s 2-3 hours from start of feeding to start of feeding. It’s really normal for babies to take 30 minutes to eat when they’re this little and sometimes up to an hour. So, if they started to eat at 9:00 am and took 30 minutes to finish up, it’s really only 1.5-2.5 hours until they’re ready to eat again.

Although there are different strategies, I think consensus is to breast feed first on one side and then the other. Generally 10-15 minutes per side allows the baby to drain the breast and get all both the thinner foremilk and the more-filling hindmilk. One of the difficult things about feeding a newborn is that milk makes them really relaxed and sleepy, you’re constantly trying to keep them awake by tickling their feet or rubbing their hands, etc so that they can get a full feeding in. It’s preferable for them to eat a meal rather than a snack so that they start to move towards a more regular feeding routine—and you have longer in between feedings to sleep, eat and take care of yourself.
Set-Up
I mentioned last night that newborns tend to eat every 2-3 hours and it takes them at least 30 minutes to finish eating which means you’re spending a good deal of your day feeding your little one. It can really help to have a comfortable feeding set-up. During the day I think a comfortable chair with good back support and padded arm rests are nice. If you have something to put your feet up on (especially if you’re short) that’s even better. You’ll want to have the phone within reach as well as some water and potentially some snacks. Breastfeeding can make you ravenous. Magazines are also good to have on hand as is the remote if you like to watch TV or videos. Basically you want a “control center” in which you’ll be able to reach everything and partake in activities that only take one hand.

At night you’ve got a few options—if you’re co-sleeping or your baby is sleeping next to your bed, you can either just sit-up in bed and nurse or feed your baby lying down. Other people like to have a comfortable chair near the bed and actually get out of the bed to feed as well. In general I think it’s recommended that the night feeds be as boring and business-like as possible, so doing them in a darkened room without any other stimulation is good. This helps you fall back to sleep faster (without being jarred awake by the light of the TV) and helps your baby to realize eventually that it’s more fun to sleep during the night and actually interact with you during the day.

At first you’ll have to change your baby’s diaper when you feed them at night. In the early weeks they basically poop every time they eat, thus you’re constantly changing diapers. At some point (anyone remember when?) their digestive cycles get more normal and you won’t have to change as many or any overnight diapers because they’ll just be wet. I mention this though, because at least at the beginning you need a changing set-up near where the baby sleeps.
Latching
I encourage you to read the Nursing Mothers Companion that I read last night and other breastfeeding material you find to get a good description and pictures of what a good latch looks like. I’m going to focus on what it is, why it’s important, and what you can do to help achieve it. The latch is basically the code word for “breast lock.” It’s a particular way that the baby will connect with your breast and nipple so that the milk glands are activated and their sucking will bring down the milk. It’s important that the latch happen so that a) the milk starts flowing when the baby “requests” it and they don’t get frustrated and b) breastfeeding is comfortable for you and not super painful.

The tips I’ve read mention holding the baby out in front of you on their side with their mouth aimed at your breast. You stimulate them to open their mouth by stroking their cheek or rubbing your nipple on their bottom lip. When they open up you quickly bring their mouth to your breast. The key is that you want them to have their whole mouth around your breast—not just sucking on your nipple like a bottle nipple.

Even with the correct latch breastfeeding may feel uncomfortable at first. Especially during engorgement your breasts are full and hard and they can hurt. Even with a great latch your baby can make your nipples feel sore, and if you have a feeding session where they aren’t latched on correctly you can find yourself with really hurting or cracked nipples that take awhile to heal since they don’t get put on the DL.

Lanolin can be used to help soothe your nipples if you have severe pain and can also just keep things moisturized if you’re having normal adjustment aches. You don’t have to wipe it off or anything as it’s safe for the baby. They also make these soothing gel packs called “soothies” which you can get at the drugstore. I never tried them but I’ve heard they are very helpful.
Positions
Again, I would encourage you to consult a book to see pictures of the various nursing positions. I just want to draw your attention to some of the most popular, and let you know that there’s more than one way to breast-feed. The most popular position is called the cradle-hold. This is probably the one you picture when you think of breast-feeding. You are supporting the baby on your left arm laying across your body and the baby is nursing on your right breast (and vice versa). This tends to be an old standby and an easy position to get the hang of. It really helps to have a pillow underneath the baby (especially when they’re tiny) so that you aren’t slumped over trying to bring your breast down to the baby. You always want to elevate the baby to your breast so that a) you don’t put strain on your back and shoulders and b) the baby isn’t actually pulling on your nipple (ow!)

Another position that I actually had better luck with at the very beginning is the side-lying position. Basically you are laying on your side in the bed and the baby is lying next to you nursing on the breast nearest the mattress. To me this just came naturally and was great in those early days after delivery when sitting up didn’t always feel comfortable. I’ve heard some moms say this position was confusing though, so like everything you’ll just have to try different things out to see what works for you.

The last “basic” position is the football hold. In this position you cradle the baby on your right arm held at your side and they’re nursing on your right breast (and vice versa). This is just another one to hold and one that I hear can be great when your c-section scars are still healing.
Feeding on the Go
Regardless of your feeding method—at some point if you’d like to get out of the house at all, you’re going to need to feed on the go. Bottle-feeding and breast-feeding both have their own considerations.
Bottle-feeding
If you are feeding your baby with a bottle (either formula or expressed milk) you’re obviously going to have to bring the expressed milk or formula with you. If you have a bottle of expressed milk you can just ready the bottle(s) before leaving and store them with a cold pak. Some diaper bags actually have insulated bottle pockets which work great if you’re just going to be out for a little while. There are also these ice pak things that are circular and go around bottles of all types. These work well to go around baby bottles—wrap them in a towel and/or put them in a Ziploc bag and you’ve got your own little cooler.

If you’re using formula you’ll need to bring the formula with you. They sell little containers that hold a pre-measured amount of powdered formula so that you can bring say 3 bottles worth of formula. You would fill 3 bottles with the right amount of water and then just open the lid on one of the containers and pour it into the bottle (the hole in the container is the right size to match up to the bottle opening.) Alternatively, I’ve seen Moms just pre-measure the formula into a dry baby bottle and then add water whenever they get where they’re going (this presumes you have access to clean water of course). If you’re just going to be out for a little while you can go ahead and make-up the formula bottle and follow the same instructions as above for keeping it cool. I know the formula is supposed to be consumed X hours after you make it up, but I don’t remember how long that window is.

With bottle-feeding, you have to think more about the stuff you’re bringing but less about where you feed the baby. While it’s nice to find some place to sit, I don’t think I’ve heard of anyone getting upset or uncomfortable seeing a baby bottle-fed.
Breast-feeding
With breast-feeding you really don’t need to bring much with you when you’re going to feed. Many moms like to bring some kind of blanket along with them (which likely you’ll have packed in your diaper bag anyway) to throw over their shoulder and the baby while they’re nursing. Other than that, you don’t need any other stuff.

You do however tend to care more about location. Even if you are the most comfortable breastfeeder in the world and you consider it a very political issue to breastfeed anytime anywhere, your baby may actually turn out to be more sensitive. Some babies (especially as they get older and more aware of their surroundings) will have trouble concentrating on eating if they’re outside, in noisy surroundings, etc. For this reason, it can be nice to find a quieter place to breastfeed—at least in my experience.

The only thing really required is a place to sit. You can breast-feed in the car, on a bench, in the “living room” portion of the ladies room at a department store, anywhere really you can find a place to sit-down and have a few minutes of quiet. You’ll find your own comfort-level for what you find doable in terms of public breastfeeding. Most times you have the car as a back-up which is always preferable to a regular bathroom.

If you are actually traveling—as in long car-trips, it can be really nice to have expressed some milk. One thing that is very difficult (although I won’t say impossible) is to breast-feed your child while they are safely strapped in the car seat. If on a long car-trip your child is hungry it’s nice to have some bottles available rather than having to pull-over or stop all the time.
Pumping
If you are planning to breastfeed exclusively they generally tell you to wait 6-8 weeks before trying to give your baby a bottle. The reason given most often is that the baby might have “nipple confusion.” The rationale goes that a baby has to open their mouth wide and latch on to your breast to feed “correctly.” With a bottle nipple you just suck the very tip and you don’t have to work too hard to get the milk out. If you introduced bottles too early the baby might not be able to make the transition back and forth. To be honest I’ve never actually heard a mom with this problem so I’m tempted to dismiss it.

However, there are other reasons for waiting to give a bottle. The primary one is that it takes awhile for your body to get into a rhythm in terms of milk production (how much and when it’s needed) and for your baby to get into any kind of routine about when they want to eat. If you are replacing one of your normal feedings with a bottle of formula (supplementing) and you do it regularly, your body will stop producing milk at that time or your supply will decrease. If you know that your husband is going to cover the 9 pm feeding every night, this might not be an issue. But if by and large you will be doing the feeding and you plan to breastfeed for the first many months, you’re better off getting into a good pattern breast-feeding for the first 6-8 weeks and then transitioning into bottles.

Also, you may have plans to pump as much as possible to have a gigantic supply of breastmilk stored when you go back to work (if that’s part of your plan). You can slowly start pumping in addition to your normal feedings of your baby by either pumping for a few minutes on each side after your baby has finished eating, or by fitting in a short pumping session (10 minutes per side) halfway between two of your babies’ normal feedings. When you first start pumping you should try these techniques in the morning because that’s when your milk supply is at its peak.

It’s totally normal to get almost nothing when you first try pumping. Some women don’t have this problem but it takes others awhile to really “produce” anything. Down the road if you are pumping 2-3 times a day (mostly likely while you’re at work) you’re much more likely to get several ounces on each side—equivalent to what the baby would be eating if s/he was breastfeeding directly.

Breastfeeding Difficulties
These are the types of things that can happen that can make breastfeeding challenging. I think it’s helpful to know that these things CAN happen so that you can focus on fixing them rather than worrying about whether or not anyone else has ever had the same problem.

Sore breasts and nipples—this is probably the most common and easiest problem to deal with. When you first start breastfeeding, as you and your baby are adjusting to the process it’s likely that everything will be a little sore and hurt a bit.

Cracked/Bleeding nipples—if your baby is sucking just on your nipple and not latching on to your entire breast, you’re likely to wind up with cracked and or bleeding nipples. Obviously this is painful and it takes awhile to really clear up because your breasts are being used pretty frequently. Lanolin cream can really help as well as something called Soothies at the drugstore.

Difficulty latching—Some babies literally just “get it” right away. You put them to the breast and they basically do the work. Others act like they can’t be expected to have this all figured out. If you are having trouble getting your baby to latch on it can be extremely stressful—your baby probably isn’t just laying there cooing at you (which by the way happens much later) while you work with her to latch on. She’s more likely screaming and getting more and more agitated the more things you try. There’s no “winning” in this situation you just keep trying different things—different positions, trying to stimulate her to open wide and then pull her quickly to your breast, meeting with the lactation consultant at your hospital (or an independent one if you’ve already come home), and if need-be giving her formula while you pump and continuing to try the breast until she gets it.

Falling Asleep—this is something we really struggled with. I wanted to make sure that Henry was getting full feedings, so I would make sure that he was actually eating 10-15 on each side. Problem is, he’d fall asleep about 2 minutes into the feeding session and I’d spend the rest of the time doing a version of a) tickle his palm until he wakes up, b) nurse him 2-3 more minutes, c) falls back asleep, d) tickle his feet until he wakes up e) nurse him 2-3 more minutes, repeat. This clearly makes 20-30 minutes of actual eating take an hour which is totally exhausting.

Wanting to nurse constantly—Ideally your baby will eat between every 2-3 hours (closer to 3 you hope). However, there are times when it seems like your baby wants to nurse literally all day. A few things—if your baby is crying try the other obvious things to soothe her first such as changing her, helping soothe her to sleep if she’s tired, walking her around for awhile if she needs a change of scenery. If none of these things help and she just ate you could also try letting her suck on your pinkie finger or a pacifier to see if it’s just the sucking motion she needs. Finally I would offer to breastfeed her and see if she really eats. If she eats a little and falls asleep, it will help you know for next time that you probably need to help her get to sleep earlier—before she gets cranky. Babies go through little growth spurts and sometimes nursing is all that they want or that will make them happy. I think it’s nice to try out your other options first, but sometimes if they really want to eat—just feed them. You won’t ruin their “schedule” in one day and they won’t be nursing all day forever.
Q & A
Q: I was told by a midwife that is essential to take a breastfeeding class. Did anyone take a class and, if so, did you find it helpful at all?

A: I did not take a class, but I should have. I think the more you know about it beforehand, the better transition it will be. Some babies are naturals but if Mom is nervous, anxious it can turn the babies off. If you have the time you should do it.

A: I didn’t take a class so was a bit unclear what was covered and how they worked—i.e. are you just seeing pictures of people breastfeeding, are you trying out the positions with dolls, etc. Based on the responses I got on the board, it seems like the classes can really vary, so of course what you get out of them can vary as well.

My short answer would be that if you have done some reading or looked at some pictures of the latch or feeding positions and it just seems like hopeless mumbo jumbo, a class might be a really helpful tool in your preparation. If you’ve looked some stuff over or been around friends or siblings that have breastfed and it generally seems to make sense to you, I’m not sure it would make that much of a difference. If you’re the kind of person that feels like the more prep the better, by all means sign up for the class.

The only thing I would say is that while some prep is good I think people can get too stressed out about how complicated the latch is. I know this really differs from baby to baby—some “get it” right away and some you really, really have to work with, but I don’t find it particularly helpful to think that if you don’t take a class there’s no way you’ll figure it out.

The other thing I would mention is that I don’t think classes, and some of what you read, prepare you for the difficulties of breast-feeding. A lot of stuff you’ll read will tell you that it shouldn’t hurt but I think honestly that depends a bit on your body and your baby. It’s true that if your nipples are cracked and bloody and you feel like you’re giving birth all over again most certainly something is wrong. If it’s uncomfortable or hurts a little at first it’s highly likely that you’re just getting acclimated to the process. Still, it’s not like getting a back massage or anything.

Q: A couple of quick follow ups on feeding. In our labor class, the nurse said that you can go ahead and have alcohol and still breast feed. I was told in the past that if you are going to have alcohol you need to get rid of the "batch" that would contain the alcohol. Also, did your doctors tell you about any diet restrictions while breast feeding? A friend of mine was told to stick to a pre pregnancy diet of no sushi, no lunch meat etc while the labor class said that you can basically eat whatever, but stay away from tuna.

A: This is kind of a grey area and you'll probably hear more opinions on this but I thought I would jump in on what I think. If you have one drink, you're probably OK with feeding the baby but if you have two or more, I'd say just skip the next feeding and pump (discarding that milk) and use your stored milk as backup.

I ate whatever I wanted during nursing but it's said some babies can be more gassy with certain foods. So just be sensitive to it, if you are noticing something a little off in the baby. You probably do want to watch certain fish due to the mercury concerns. Big ocean fish, tuna, swordfish and others. Just don't have them more than once or twice a week.

Bottom line though, do what you are most comfortable doing. If you don't want to fee the baby after one drink, then just plan ahead an pump a little extra for the fridge the day before or day of your outing.

A: I agree with Tab that this is one area you’re likely to hear a lot of conflicting advice. I believe this is because the standard guidance that used to be provided regarding drinking and pumping has changed in just the last year or so. They used to tell you that if you were going to drink you needed to pump after the feeding and dump that milk. I believe now they tell you what you heard at your class—that it’s okay to either pump normally or feed normally after drinking.

I believe they also tell you that your best off feeding or pumping right after (or during!) having a drink because it takes 2-3 hours for the alcohol to make it to your milk supply. I also think that this advice pertains to having one drink slowly—not binge drinking or taking shots—anything where you’re rushing alcohol to your blood/milk supply.